癌症晚期，全身多处转移的病人，还能有根治期盼吗？
在<span style="color: black;">非常多</span>人眼中，癌症<span style="color: black;">表率</span>了绝望，而晚期癌症、全身多处转移，<span style="color: black;">更加是</span>等同于接到了死神的<span style="color: black;">通告</span>书。但其实，有的时候，即便是晚期癌症<span style="color: black;">亦</span>仍有根治的<span style="color: black;">期盼</span>。<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">数个月前，孙先生<span style="color: black;">显现</span>了<span style="color: black;">没</span><span style="color: black;">显著</span>诱因的消瘦、便不成型等问题，但他<span style="color: black;">无</span>当回事。</p><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">两个月后，经过一系列<span style="color: black;">检测</span>，孙先生的肺部检出了少许磨玻璃结节，还存在肿瘤标志物<span style="color: black;">上升</span>、直肠占位和结肠息肉、肝脏多发肿块等多项问题。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">经过活检，孙先生被确诊为高位直肠癌，且存在肠病灶的淋巴转移、肝转移（多发），分期<span style="color: black;">思虑</span>为T3N2M1。（肺部结节暂时<span style="color: black;">没</span>法判定良恶性）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">之后，孙先生便<span style="color: black;">起始</span>了FOLFOXIRI化疗<span style="color: black;">方法</span>（1周期单纯化疗，后面治疗联合西妥昔单抗），<span style="color: black;">截止</span>术前，一共做满了6个周期化疗。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-264b284160788282f0080eb1f0e20702_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">起始</span>化疗约2个月后，<span style="color: black;">因为</span>效果较好，孙先生接受了肝转移部分切除+胆囊切除+术中射频消融术（处理了28个肝转移病灶）的治疗，肝门淋巴结未切除。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">孙先生术后<span style="color: black;">一月</span>接受复查，肝脏基本<span style="color: black;">无</span>什么<span style="color: black;">反常</span>，肿瘤标志物<span style="color: black;">亦</span>都还不错。<span style="color: black;">不外</span><span style="color: black;">经过</span>肝脏MR<span style="color: black;">检测</span>，查出孙先生肝脏尚存在一处3cm<span style="color: black;">上下</span>的病变。<span style="color: black;">另一</span>他还<span style="color: black;">显现</span>了便血问题。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">虽然<span style="color: black;">日前</span>肝脏<span style="color: black;">状况</span>相对稳定，但<span style="color: black;">针对</span>孙先生<span style="color: black;">来讲</span>，更<span style="color: black;">要紧</span>的是，经过肝转移灶治疗后，自己<span style="color: black;">可否</span>还有机会根治肠道肿瘤，争取到治愈机会。<span style="color: black;">另外</span>，<span style="color: black;">大夫</span><span style="color: black;">意见</span>他再接受6个疗程的化疗（<span style="color: black;">方法</span>同前）进行巩固，这<span style="color: black;">亦</span>令他有些担心。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，孙先生找到了盛诺一家，<span style="color: black;">期盼</span><span style="color: black;">经过</span>专家会诊的形式，<span style="color: black;">知道</span>后面的治疗方向，并且对复查中<span style="color: black;">发掘</span>的肝脏病变和肺磨玻璃结节进行评估，<span style="color: black;">瞧瞧</span>该<span style="color: black;">怎样</span>应对。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-d0b78f68d1823c87e1bf2891823b2f7b_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">专家会诊给出的<span style="color: black;">意见</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于肝脏转移灶治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">孙先生的肝脏病灶切除基本干净，虽然近期肝脏MR<span style="color: black;">发掘</span>了3cm的一处病变，但结合肿瘤标志物的变化趋势，<span style="color: black;">能够</span>认为该病变属于肉芽组织的概率<span style="color: black;">很强</span>，是肝转移灶的概率较小，<span style="color: black;">因此呢</span><span style="color: black;">意见</span>随访观察。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>，孙先生的肝脏病灶仅<span style="color: black;">经过</span>一次切除，很难完全切除干净。切除后，会有<span style="color: black;">很强</span>概率<span style="color: black;">显现</span>新发病灶。<span style="color: black;">因此呢</span>他接下来可能还<span style="color: black;">必须</span>进行1-2次的再切除手术。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于治疗方式的<span style="color: black;">选取</span>，<span style="color: black;">倘若</span>外科<span style="color: black;">大夫</span>在术前判断，手术切除后的肝脏预期剩余百分比不足30%，则<span style="color: black;">能够</span><span style="color: black;">思虑</span><span style="color: black;">选取</span>介入治疗，如动脉栓塞术<span style="color: black;">或</span>射频消融术；<span style="color: black;">倘若</span>预期剩余肝脏大于40%，则<span style="color: black;">思虑</span><span style="color: black;">选取</span>外科手术切除。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q2</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于肠道肿瘤的根治</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">从<span style="color: black;">病人</span><span style="color: black;">供给</span>的影像<span style="color: black;">检测</span><span style="color: black;">能够</span>看出，肠道肿瘤<span style="color: black;">已然</span>在化疗后有<span style="color: black;">显著</span>缩小，<span style="color: black;">此刻</span><span style="color: black;">能够</span><span style="color: black;">思虑</span><span style="color: black;">选取</span>手术。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>暂时不打算手术，<span style="color: black;">亦</span><span style="color: black;">能够</span>继续化疗缩小病灶。<span style="color: black;">日前</span>，国际主流方式是将化疗安排在肠癌术前，<span style="color: black;">由于</span>术后化疗对<span style="color: black;">病人</span>预后影响不大。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>，<span style="color: black;">病人</span>化疗<span style="color: black;">方法</span>中用到的西妥昔单抗在用药后5周<span style="color: black;">才可</span>完全在<span style="color: black;">身体</span>清除，<span style="color: black;">因此呢</span>在末次化疗结束4-6周后就<span style="color: black;">能够</span>手术。不过术前<span style="color: black;">必须</span>再进行<span style="color: black;">评定</span>，<span style="color: black;">倘若</span>还有肝转移灶，<span style="color: black;">能够</span><span style="color: black;">同期</span>进行肝脏+肠道的肿瘤切除术，术式可<span style="color: black;">选取</span>腹腔镜手术，手术的难度并不高。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q3</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于术后化疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">孙先生在术前<span style="color: black;">已然</span>做了6个周期充足的术前化疗，术后巩固化疗带给<span style="color: black;">病人</span>的收益会比较小。不仅如此，<span style="color: black;">思虑</span>到<span style="color: black;">病人</span>肝脏<span style="color: black;">已然</span><span style="color: black;">由于</span>肿瘤和治疗<span style="color: black;">显现</span>了<span style="color: black;">必定</span>的<span style="color: black;">损害</span>，<span style="color: black;">倘若</span>再做6个疗程化疗，很容易带来<span style="color: black;">更加多</span>的肝脏毒性，<span style="color: black;">导致</span>肝衰竭<span style="color: black;">危害</span><span style="color: black;">提升</span>。<span style="color: black;">因此呢</span>不<span style="color: black;">意见</span>术后巩固化疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q4</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于<span style="color: black;">可否</span>有更好的化疗<span style="color: black;">方法</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不必过于关注个别的<span style="color: black;">科研</span>结果，就迄今为止的化疗而言，<span style="color: black;">病人</span>此前接受的Folfoxiri+西妥昔单抗组合是非常有效的，药效相对其他<span style="color: black;">方法</span><span style="color: black;">来讲</span>更强。<span style="color: black;">倘若</span><span style="color: black;">病人</span>可耐受该<span style="color: black;">方法</span>且<span style="color: black;">无</span><span style="color: black;">显现</span>严重副<span style="color: black;">功效</span>，后面<span style="color: black;">倘若</span>再<span style="color: black;">必须</span>化疗时，还是可以继续沿用该<span style="color: black;">方法</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q5</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于术中没切除的肝门淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>问及的肝门淋巴结，是一个非常<span style="color: black;">要紧</span>的部位，<span style="color: black;">因此呢</span>手术时，<span style="color: black;">大夫</span><span style="color: black;">必定</span>会对此处进行探查和确认。<span style="color: black;">无</span>切除的<span style="color: black;">原由</span>，大概率是<span style="color: black;">由于</span>术中<span style="color: black;">大夫</span>判定其为良性病变，<span style="color: black;">因此呢</span>不必过分担心。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q6</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于检出的肺磨玻璃结节</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">此处结节可能是炎症<span style="color: black;">或</span><span style="color: black;">初期</span>癌症。虽然<span style="color: black;">药品</span>治疗<span style="color: black;">时期</span>复查稍有缩小，但仍很可能是生理性变化。<span style="color: black;">不外</span><span style="color: black;">没</span>论是良性结节还是恶性，现<span style="color: black;">周期</span>都<span style="color: black;">无</span>治疗的必要，继续随访观察<span style="color: black;">就可</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q7</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于便血问题</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>应尽快接受肠镜<span style="color: black;">检测</span>，<span style="color: black;">倘若</span><span style="color: black;">发掘</span>易<span style="color: black;">流血</span>病变，则应尽快接受手术。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Q8</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">关于<span style="color: black;">可否</span>有根治可能</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">按照</span>对孙先生当前的各项<span style="color: black;">检测</span>进行分析，他的状态属于预想中<span style="color: black;">尤其</span>好的<span style="color: black;">状况</span>，虽然<span style="color: black;">将来</span>的治疗可能会很辛苦，但<span style="color: black;">保持</span>下去仍完全有根治的可能。</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">案例分析：</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在本案例中，孙先生确诊时<span style="color: black;">已然</span>是肠癌晚期，且肝脏存在<span style="color: black;">海量</span>转移。在<span style="color: black;">一般人</span>看来，孙先生的<span style="color: black;">情况</span>不大可能治愈了。但经过专家会诊，孙先生<span style="color: black;">知道</span>了自己还有根治的可能。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这<span style="color: black;">便是</span>专家会诊的<span style="color: black;">道理</span>所在，尤其是多学科会诊。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>，不少人认为，术后化疗<span style="color: black;">能够</span>降低清除掉<span style="color: black;">病人</span><span style="color: black;">身体</span>循环系统中残存的癌细胞，<span style="color: black;">因此呢</span><span style="color: black;">必定</span>要做，<span style="color: black;">况且</span>做得多收益更高。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但<span style="color: black;">实质</span>上，在<span style="color: black;">非常多</span>时候，术后化疗对某些<span style="color: black;">病人</span>的收益微乎其微。<span style="color: black;">疾患</span>治疗应当遵循的，不是千篇一律的思维模式，而是因人而异、因病而异的个性化诊疗理念，以<span style="color: black;">靠谱</span>的临床<span style="color: black;">实验</span>数据为支撑，为<span style="color: black;">病人</span><span style="color: black;">供给</span>更好的<span style="color: black;">方法</span>。</p>
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